Inspection on 16/03/06 for The Orchards

This inspection was carried out on 16th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Orchards 21/10/09

The Orchards 23/05/07

The Orchards 07/10/05

The Orchards 10/12/04

The Orchards 08/06/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Orchards 140/142 Birkrig Skelmersdale Lancashire WN8 9HY Lead Inspector Mrs Lynne Lynch Unannounced Inspection 16th March 2006 10:40 The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Orchards Address 140/142 Birkrig Skelmersdale Lancashire WN8 9HY 01695 726118 01257 450630 dawaking@talk21.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dawaking Care Ltd Mrs Lesley Ferguson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of seven service users requiring personal care who fall into the category of LD - Learning Disability. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued Through the Commission for Social Care Inspection regarding staffing levels in care homes. 7th October 2005 3. Date of last inspection Brief Description of the Service: The Orchards is a large end terraced house comprising of two properties in the Digmoor area of Skelmersdale. It is close to local shops and amenities. The home has been extended and adapted to provide long term care for seven people all of whom have a learning disability. Service users are accommodated in single rooms situated on three floors. The home is able to accommodate a service user with a physical disability providing ramps to the front and rear of the home, a ground floor bedroom and a ground floor shower room. There is a separate kitchen, dining room and two lounges. A well-maintained garden can be accessed through the dining room. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, started at 10.40am and took place over four hours. There are currently six people living at the home. At the time of the inspection two individuals were at home, with four attending local day centres or college. The inspector spoke with the manager of the home and spent time with the two service users. Feedback from one lady living at the home was limited as she has specific communication needs however the other person spoke at length with the inspector. Care, administration, medication and training records and some of the written policies were viewed. Comment cards providing feedback about the service were received from five relatives and one health/social care professional in contact with the home. Staff had also supported two service users to complete comment cards. One of the service users completed the comment card on behalf of another as she has a close relationship with this person. Further information was provided via a pre inspection questionnaire completed by the manager of the home. Key standards not assessed at this inspection will have been addressed at the previous inspection on the 7th October 2005. What the service does well: The staff provide good opportunities for people to be part of and participate in community life. Care plans in the home provide good guidance for staff to ensure personal care needs are appropriately met for each individual. There was good evidence within the care plans and written records of service users being supported to make decisions. The provider organisation arranges a good rolling programme of mandatory training. Staff are encouraged to complete a self-assessment, the manager then completes an appraisal, training needs analysis and training plan. There is evidence of the staff team implementing good diversion techniques to deal with challenging behaviour. There is a well-organised system of health and safety checks, with good records being maintained. During the inspection the staff on duty demonstrated good communication skills. Staff have clearly built up good relationships with people living at the home and know individuals well. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 6 The registered manager runs the home ensuring good service user involvement and continues to maintain good contact with the Commission for Social Care Inspection and ensures any requirements or recommendations made at inspections are swiftly responded to. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were inspected at this visit. EVIDENCE: The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Service users are given appropriate support to make decisions. EVIDENCE: Within the care plans and written records there was good evidence of service users being supported to make decisions. One lady’s care plan gave guidance to staff to ensure that when choice is given, the choice should be limited to ensure that she isn’t overwhelmed and is able to make a clear choice. The person spoken to during the inspection talked about making decisions for themselves in respect of work, leisure and daily activities. The inspector observed the manager supporting this person to make a decision regarding college attendance and whether she would like to visit a relative. She also spoke about her decision to attend her local church and to help form a singing group. Five comment cards were received back from friends /relatives. All confirmed that they were consulted in respect of their friends/relatives care particularly when they are unable to make decisions for themselves. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 16 Good opportunities are provided for people to be part of and participate in community life. Daily routines promote independence. EVIDENCE: Each person in the home has a plan of activities for both inside and outside the home and staff are planned on the rota to ensure these activities take place. Discussion with staff and service users evidenced that this was the case. The home has a close relationship with the local church and several service users are members of a singing group, which has developed with the support of the church. Service users care plans provide good guidance for staff regarding specific support required for individuals to access the community. One service user spoken with explained how she collected her money from the post office and accessed local shops in the area to purchase toiletry items for herself and others in the home on a weekly basis. Records showed that service users regularly visited cafes, pubs, the local swimming baths, college and horse riding centre. The home has its own transport, however taxis and buses are also utilised. One service user said “ I like to do the shopping at Asda for everyone”. The home maintains contact with a local advocacy service. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 11 The written policy regarding daily routines was viewed and contains guidance for staff regarding privacy and rights. Restrictions regarding access to the kitchen where noted on one lady’s care plan, however this does not effect other service users in the home as they have access to the key and fully understand the reasons for this restriction due to health and safety requirements. A number of people have a key to their bedroom, this being agreed individually according to wishes and capabilities. It was evident from the visit that service users were regularly involved in the running of the home, One service user in particular had a good knowledge of how the home ran and was happy to be involved. She also spoke to the inspector about routines and advised that these were flexible, however for some service users their routines needed to be set to support them. She advised the inspector that a new person was coming to view the home and said “a new lady is coming to look round tomorrow, she might want to live here, Lesley (manager) said it is important we meet her, to see if we think she is right for here”. Minutes from a recent residents meeting were viewed and showed that service users had discussed and planned a holiday abroad. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 The personal and health care needs of individuals are met. Good practice and a thorough self-audit system ensure that medication is handled and administered correctly. EVIDENCE: The two care plans viewed gave good guidance to staff in relation to personal care, with one lady’s plan advising that she preferred certain tasks being carried out whilst she was in the bath and guidance as to when to remove clothes for the laundry to ensure the least distress is caused. It was also noted on one care plan that one lady was allergic to perfumed toiletries and guidance was given regarding which toiletries were to be used. An en suite facility has been added to one bedroom at the service users request and she advised she was pleased with this as it gave her more privacy. Staff have received training prior to administering any medication. One member of staff has responsibility to oversee medication. Medication is stored in a locked cabinet in a locked cupboard. A system of thorough self-audit is in place with any errors being quickly noted recorded and addressed. The records viewed were appropriately maintained, with no dose or signature omissions. There is a clear procedure in place for administration, with evidence of staff signatures. Each care plan contains a document signed either by the service user or their representative giving authorisation for medication to be administered. Patient information The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 13 leaflets are kept in a file ensuring staff are well informed about the medication and any possible side effects. One service user administers her own inhalers and creams and signs her own mar sheet, which she showed to the inspector. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Good practices and policies are in place to enable concerns to be raised and responded to and to protect residents from abuse. EVIDENCE: A complaints procedure is in place in a suitable format to aid understanding of the process. Regular meetings take place for the people living at the home where concerns can be raised. A resident said that their views and requests can be made and are responded to. The resident who spoke to the inspector said that she would speak to the house manager if she were unhappy about anything. She also said, “I can speak to any of the staff, if I say I don’t like it they change it”. Relatives advised on comment cards that they were aware of the homes complaints procedure and only one of these advised that they had needed to raise a concern. The abuse and whistle blowing policies are clearly written and staff sign to confirm that these have been read. The required amendment to this policy requested in the last inspection report has now been made. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Good practice and policies ensure that the home is clean and hygienic. EVIDENCE: The home appeared clean and hygienic at the time of inspection. Staff and service users work together to keep the home clean and have weekly tasks identified. The home has recently obtained guidance from the food standards agency regarding good practice in areas such as food preparation, cooking, cleaning and cross contamination. Within this guidance there is a planning tool to devise cleaning schedules and this is being implemented by the home. The home has a contract for the collection of clinical waste and protective clothing is available. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 The numbers, skills and effectiveness of the staff team reflect in positive outcomes for service users who are able to pursue their individual wishes and lifestyles. EVIDENCE: New staff are inducted to the home with an initial two week assessment, which is then followed with three and six monthly assessments. Staff are mentored during this time. A training matrix is in place, which covers all areas of mandatory training. Planned training courses were evidenced in the homes diary. Staff follow the Learning Disability Award Framework and are then encouraged to register for NVQ training. Seven staff have completed NVQ qualifications and a further four staff are registered to commence this. The home is a member of the North West Training Consortia with the manager being a member of the training board. All training is in keeping with Sector Skills Council training specifications. Staff are encouraged to complete a selfassessment, the manager then completes an appraisal, training needs analysis and training plan. A number of identified training and development opportunities have been identified on the homes training development plan. One lady in the home has specific communication needs, however it was evident from observation of service users and staff that she is enabled to communicate her needs. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 17 Staff rotas show that there are at least two staff on duty during the day and evening, including weekends. At the time of the inspection two staff were available to meet the needs of the two people who were not attending day services, meaning that if they chose to go out, both had individual support. However it was felt that at times the staffing was compromised by the increasing health care needs of one individual due to a regressive health condition. This means that this individual requires an additional 30 hrs support a week to enable him to attend therapy sessions and health appointments. The home is at present trying to access additional funding to provide additional staff hours, which are currently not covered by his existing, care package therefore ensuring that each individual in the home receives appropriate support. This gentleman’s parents commented via a comment card that they felt additional staffing was required. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 The home is well managed and run in the best interests of the service users. Systems are in place to promote residents safety. EVIDENCE: The registered manager of the home holds an NVQ 3 in promoting independence, an NVQ 4 in care and management and the Registered manager’s award. She is currently studying for her A1 unit and has extensive experience of working with people who have a learning disability. The manager’s job description is comprehensive and clearly outlines her responsibilities. The provider organisation has supported her to undergo supervision training, health and safety, train the trainer in ‘physical intervention’ and she has also attended two courses in relation to the protection of vulnerable adults. The service user spoken to was happy with the management of the home and had a good knowledge of the lines of accountability and the infrastructure of the organisation. Staff, service users and relatives all felt the home was well The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 19 run with the interests of the service users at the forefront to all decisions made. Written policies and procedures address things such as; accidents, manual handling and medication, which guide staff in their daily work. Staff sign these documents to confirm they have been read and understood. Risk assessments are in place for certain working practices. Records are kept of the health and safety checks regularly carried out by staff. These include fridge, freezer, emergency lighting and water temperatures. A service user spoken with confirmed the home have regular fire drills and a fire alarm test is carried out weekly. All fire equipment was checked in July 2005. Records show that staff have received training and guidance in moving and handling, medication, first aid, infection control, fire safety and food hygiene within their induction and these areas of mandatory training are refreshed. The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 3 X 3 X X X X X 3 The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Orchards DS0000005979.V279190.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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